Acupuncture sara bowling may2016 pci conference
- 1. ACUPUNCTURE IN PALLIATIVE CARE EVIDENCE BASED MEDICINE Sara Bowling, MD Family Medicine and Medical Acupuncture Family Care Network
- 4. Symptom A Symptom D Symptom C Symptom B
- 5. THE PILL BURDEN Average elderly patient is on 8-13 medications
- 6. Anorexia Anxiety Constipation Delirium Depression Diarrhea SYMPTOMS IN END OF LIFE Dyspnea Fatigue Nausea andVomiting Pain Respiratory tract secretions
- 7. Dexamethasone Diazepam and Lorazepam Docusate and Senna Haloperidol Amitriptyline and Fluoxetine WORLD HEALTH ORGANIZATION ESSENTIAL MEDICATIONS LIST FOR PALLIATIVE CARE Loperamide Morphine Metoclopramide Ibuprofen Hyoscine butyl-bromide
- 8. Dexamethasone - A Diazepam/ Lorazepam- D Docusate and Senna-D Haloperidol - A Amitriptyline and Fluoxetine EVIDENCE BEHIND MEDICATIONS Loperamide - D Morphine - A Metoclopramide Ibuprofen Hyoscine butyl-bromide
- 9. SIDE EFFECTS Dexamethasone Anaphylactic reactions, acute myopathy, perineal irritation, psychiatric disturbances Haloperidol QT prolongation, anticholinergic effects, leukopenia, CNS depression, extrapyramidal symptoms, esophageal dysmotility, orthostatic hypotension Morphine Constipation, CNS depression, hypotension, hypersensitivity reaction, respiratory depression
- 11. ACUPUNCTURE IS SAFE Rare Adverse Events Dizziness Subcutaneous bleeding Mild burn
- 12. ACUPUNCTURE IS SAFE Special Considerations Never placed in tumor or ulcerated area Never placed in limbs prone to lymphedema Care when treating over chest wall in cachectic patients No electroacupuncture if pacemaker
- 14. WHAT IS ACUPUNCTURE? Originated 2000 years ago North America in the 1970s as useful for anesthesia A series of meridians through which energy ïŹows
- 15. THE SCIENCE OF ACUPUNCTURE?
- 17. PAIN MODULATION
- 18. ENDOGENOUS OPIOIDS Stimulates release of dynorphin, enkephalin, beta-endorphin. Increases endogenous cannabinoid receptors Up-regulates opioids in inïŹamed tissues
- 19. ENDOGENOUS OPIOIDS Opioid antagonists such as naloxone, can reverse the analgesic effects of acupuncture.
- 20. NATIONAL INSTITUTE OF HEALTH CONSENSUS STATEMENT, 1997 âAcupuncture is an effective treatment modality for adult postoperative and chemotherapy nausea and vomiting.â âThere is sufïŹcient evidence of acupunctureâs value to expand its use into conventional medicine and encourage further studies of its physiology and clinical valueâ
- 21. ACUPUNCTURE IS EVIDENCE BASED MEDICINE Research / DataClinical Expertise PatientValues & Expectations
- 22. The challenges of the acupuncture control: SHAM acupuncture
- 24. WHOâS 3- STEP LADDER FOR CANCER PAIN RELIEF
- 25. PAIN
- 26. PAIN
- 28. FATIGUE
- 29. HOT FLASHES
- 30. INTEGRATIVE EVIDENCE BASED MEDICINE Research / DataClinical Expertise PatientValues & Expectations
- 31. Acupuncture is effective for Pain control Nausea and vomiting Fatigue Hot ïŹashes It is best used alongside conventional medicine early on in treatment, rather than as last resort
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